In 1987, during my freshman year at Lehigh University, our first English assignment was to write a letter to an elected official advocating for a controversial issue of our choosing. I decided to write my United States congressman to express why I believed marijuana should be legalized.
What was supposed to be a three to four-page paper evolved into 11 pages, with each fact properly cited. I argued that people would be less likely to get marijuana laced with pesticides or other toxins; it could be taxed to generate much-needed revenues for the government; it would lower the crime rate and the overall cost to society. Besides being the most popular paper in the class, I received my first ‘A’ in college!
After that, I transitioned through a pre-med curriculum, medical school, and pediatric residency, not thinking much about medical cannabis until California passed its first law in 1996. That was also the first year I started using wholistic therapies in my medical practice. Since California was more than 3,000 miles away, I didn’t pay much attention to what was happening there. I did, though, start using medicinal herbs to treat children.
Over the next 20 years, I collaborated with parents to develop individualized treatment protocols using mostly natural products. The goal was to help children with autism, and subsequently, many other chronic medical conditions. Parents would ask me (or tell me) about tests and treatments of which they learned. I began attending and eventually lecturing at conferences sponsored by the Autism Research Institute. The ability to be able to order medical cannabis for children one day legally was never something I considered becoming a reality.
Incorporating Cannabis into Medical Treatment Plans
Fast forward to 2016, when Florida passed its first medical cannabis law, which allowed for the use of liquid and capsule form cannabidiol (CBD) for people with cancer, muscle spasms, and seizures. Since quite a few of my patients with autism had either seizures or tic-like movements that included muscle spasms, I became a cannabis certifying physician so that I could provide additional treatments for qualified patients.
From there I began treating patients with CBD and quickly saw clinical improvements. Reduction of anxiety and/or irritability were soon being reported. Kids were sleeping better. Some children stopped stimming. Tics improved. We were definitely on to something.
But not all children improved, and in 2017, “regular” cannabis, containing 9-delta Tetrahydrocannabinol (THC) became available. THC is what causes the euphoric/psychoactive effect typically associated with marijuana use.
Improvements to Medical Cannabis Laws
Under the new law, licensed physicians who become certified by the State can authorize qualified patients to receive medical cannabis; this includes children, as long as a second doctor agrees. Certified doctors can also now authorize cannabis use for patients suffering from debilitating medical conditions similar to those listed in the statute, such as Post-traumatic stress disorder (PTSD), Parkinson’s disease, Crohn’s disease, etc.
With the new law in place, I quickly concluded that, similar to patients with PTSD, many people with autism suffer similarly debilitating anxiety, panic attacks, insomnia, and aggressive behaviors. Others had difficulty speaking, as is common in people with Parkinson’s disease, or had chronic abdominal issues similar to those associated with Crohn’s disease. With fully-informed parental consent, the parents/caregivers are allowed to purchase, possess, and administer medical cannabis to the children.
To be clear, very minimal research has been conducted on the use of cannabis in children. There are concerns about memory and cognitive function, especially when a developing brain is exposed to THC. It is critical that parents take into account the potential benefits and risks, as well as the alternatives when deciding on any treatment for a child.
Doing nothing is one alternative, but for most families, that is not an option. Pharmacological intervention is often considered. However, many families tell me that they are considering medical cannabis because other medications either didn’t work well enough or brought unacceptable side effects. Some also say that they are uncomfortable placing their child on specific prescription medications because of the reported side effects.
Starting Medical Cannabis
When I introduce medical cannabis to a patient, I recommend starting with a CBD/low-THC product (the lower the THC, the better) and gradually increase the dose. The effects are usually seen relatively quickly. Within two to three days the responsiveness to a product and dosage should be apparent. Most patients begin taking medical cannabis three times per day. Others get satisfactory results using it as needed, once or twice a day, or by micro-dosing. With micro-dosing, very small doses are taken every hour or two or a transdermal patch is used.
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Routes of Administration
The various routes of administration available to patients have significantly expanded. While I firmly believe nobody should SMOKE anything (be it tobacco or banana leaves), inhaling cannabis is the most efficient way to produce the desired effect.
In Florida, certified doctors can now order inhaled products for patients to ingest through nasal delivery, asthma-like metered dose inhalers, or vaporized. I know of young and low-functioning children who are being taught to inhale cannabis through these various methods.
Smoking Versus Dry-Vaping
It is important to understand how vaporizing is different than smoking. The key distinction involves the temperature at which the cannabis is exposed. At a high enough temperature, a plant will burn. But at lower temperatures, the essential oils are released as vapor, and nothing is burned. Although vapor can be seen in the exhalation, which looks similar to smoke, no smoke is inhaled. When this is done with the flower of cannabis, it is called dry-vaporizing.
When cannabis is vaporized as an oil, several techniques can be used to isolate the cannabinoids (such as THC and CBD) and terpenes. Terpenes are the other main chemical type in cannabis that can induce different effects such as sleep, providing energy, pain reduction and relief from mental health issues. The terpenes and cannabinoids are then brought back together, usually in MCT/coconut oil or cannabis oil, in various ratios. There are also high-pressure methods that “squeeze” out the oils that are then collected.
Pediatric Medical Cannabis
As one of the first board-certified pediatricians in the State of Florida to specialize in pediatric cannabis therapy, I am relatively sure I have certified more children for medical cannabis treatment than any other doctor in Florida. Every day at my clinic I hear about another child whose life is improved and whose entire family has benefited because of medical cannabis.
For out-of-state families, I provide educational consultations where I consult on how to put together a protocol to optimize the use of medical cannabis. When requested, I also help families shop online if they tell me the dispensaries/products that are available to them.
As I look back over this 30-year journey, I am amazed how far we have come. I look forward to hearing many more amazing and inspiring stories about people with autism and other qualifying conditions whose lives have been transformed with medical cannabis.
An abbreviated version of this article was published in April 2019 as a blog on the Wholistic Pediatrics and Family Care website.
This article was featured in Issue 90 – Practical Ways to Build Skills for a Lifetime